White Papules on the Backs of a Middle-Aged Man and His Son.

A middle-aged man came in for evaluation of "white spots" on his upper body. The number of lesions had increased progressively over the past 20 years but were asymptomatic. The patient expressed concern that his young son had recently developed similar lesions on the upper part of his back. Physical examination revealed numerous, slightly elevated, flat-topped papules scattered over the back, chest, and upper extremities (Figure 1). Each 4- to 6-mm papule was oval or round, ivory white, with a cobblestone surface. The patient's son was also examined and found to have six papules scattered across the upper part of his back and legs, identical in morphology to those of our patient. A shave biopsy was taken from of one of the papules. Results from routine hematoxylin-eosin, as well as Melan-A sections, are shown (Figure 2). The diagnosis was familial keratosis alba or familial hypochromic seborrheic keratosis.

Gene expression profiling for cardiac rejection surveillance is not predictive of post-transplantation skin cancer.

BACKGROUND: The risk of skin cancer in solid organ transplant recipients (SOTR) is 50 to 100 times as great as in those without a transplant. Multiple factors, including immunosuppression, influence the development of post-transplantation skin cancer. Individuals with cardiac transplant are serially screened for organ rejection and immunosuppressive regimen effectiveness. Gene expression profiling of peripheral blood mononuclear cells has been established as a noninvasive test for monitoring cardiac rejection. OBJECTIVE: We examined individuals with cardiac transplant monitored using peripheral gene expression profiling to determine whether the profile of peripheral blood mononuclear cell activity could correlate with the development of post-transplantation skin cancer. METHODS AND MATERIALS: Sixty-one patient records were examined for initial endomyocardial biopsy results, gene expression profiling data, immunosuppressive regimens, and post-transplantation skin cancer. RESULTS: There was no relationship between acute rejection and the development of skin cancer. No relationship between peripheral gene expression profiling and the development of post-transplantation skin cancer was observed. The most common skin cancer in the population was squamous cell carcinoma. SOTR suppressed with azathioprine had a significantly higher incidence of squamous cell carcinoma. CONCLUSION: Although gene expression tests have advanced transplant surveillance, they were not associated with post-transplantation skin cancer.

A survey-based evaluation of dermatopathology in the United States.

A survey-based assessment of dermatopathologists (DPs) regarding their workload, job satisfaction, and compensation has not been previously undertaken. We e-mailed approximately 1000 DPs in the United States requesting them to complete an anonymous and confidential 20-question online survey and received 110 replies. Not all answered each of the questions posed, however. Some of the responses were stratified with regard to the nature of the DPs' practice, that is, academic versus private. DPs with training in pathology, dermatology, or both comprised 64, 36, and 9 respondents, respectively. Seventy-one DPs were in private practice with 35 employed by academic institutions. DPs expressed a high degree of job satisfaction with 88% (30) of academics and 83% (59) of private practitioners stating that they were very or somewhat satisfied with their practice. Average annual compensation for DPs in private practice was $525K and $366K for those in academics. This may relate to the larger percentage of private DPs signing out 10,000 or more cases annually compared with academic DPs (59% vs. 22%). These yearly compensation figures are greater than available estimates for dermatologists or pathologists and most other medical disciplines.